test yourself

Here are some actions taken during your daily routine. Rate the degree of disability you feel about this action

Getting dressed

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

(Walking (Standard walking in the plane

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

Showering

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

Performing household chores

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

Walking fast about 0.5 km

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

Lifting heavy objects

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I feel no restriction
I have some restriction, but it is caused by a different medical problem

Correct!

Wrong!

Performing sports activities

I feel very restricted, it's hard for me to do it myself
I feel fairly restricted, but can do it myself, slowly and over a long time
(I feel moderately restricted (sometimes it is very difficult and sometimes less
I feel a bit restricted, most of the time I manage to do it all by myself
I have some restriction, but it is caused by a different medical problem
יש לי מגבלה אבל היא נובעת מבעיה רפואית אחרת

Correct!

Wrong!

In the last two months, when I performed strenuous physical activity, I felt pain/stress or distress

Much more often
A little more often
About the same
A little less often
Much less often
No chest pains

Correct!

Wrong!

In the last month I felt pain/stress or distress

4 times or more a day
1-3 times a day
3 or more time a week but not every day
1-2 times a week
Less than once a week
Never in the last 4 weeks

Correct!

Wrong!

In the last month I took Isochut spray (or nitroglycerin) on the average

4 times or more a day
1-3 times a day
3 or more time a week but not every day
1-2 times a week
Less than once a week
Never in the last 4 weeks

Correct!

Wrong!

:In the last month I feel that the chest pains I experience

Severely limit my quality of life
Fairly limit my quality of life
Moderately limit my quality of life
Somewhat limit my quality of life
Do not limit my quality of life

Correct!

Wrong!

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